Fast Breathing, Poor Feeding, Blue Lips: Early Congenital Heart Defect Signs Indian Parents Miss

Congenital Heart Defect (CHD) is a problem with the heart's structure that is present at birth. The structural changes impact blood flow. Some of these include a hole in the wall of the heart, issues with blood vessels, and problems with heart valves, among others. While some cases of CHD are simple and may not cause any symptoms, others can be life-threatening. The child may need several surgeries which are done over a period of several years. In some cases, signs of CHD may be subtle and parents tend to look away from these. However, if you spot the early signs of CHD, it can help in early treatment and also prevent it from turning fatal. Check out the early signs of congenital heart defect.

Early Congenital Heart Defect Signs

1. Repeated Chest Infections

Frequent chest infections may be the only feature of heart disease in a child. Upper respiratory infections like common cold, mild cough or hoarseness are not related to heart disease. Chest infections usually manifest with fever, fast breathing, indrawing of the chest and usually require antibiotics for recovery. More than one episode of lower respiratory tract infection in a year may be the only clue to the existence of congenital heart disease in a child.

2. Feeding Problems

Inability to take feeds at a single stretch especially when associated with sweating is an early manifestation of congenital heart disease. Feeding difficulty is considered to be present if the baby cannot take feeds from the breast at a stretch for five minutes and becomes breathless during feeds. The baby may also sweat during feeds and stop after taking a small feed. The baby continues to be hungry and cries after every half-an-hour to 1 hour for feed.

3. Unsatisfactory Weight Gain

Infants with congenital heart disease have poor feeding patterns and unsatisfactory weight gain.

4. Unable To Keep Pace While Playing

If your child is unable to keep pace with his/ her friends of the same age while playing, it could be a sign of CHD. This may indicate that a diseased heart cannot cope with the demands during exertion and competitive sports.

5. Child Is Blue

Blueness is an important indicator of heart disease. Blue babies always have a severe form of heart disease. The earlier the blueness appears, the more serious the heart defect. Some of the blue babies are prone to episodes of "Cyanotic spells", characterised by increase in the rate and depth of breathing with increase in blueness. This may go on to limpness, convulsion, or unconsciousness.

What Should Parents Do?

If you notice any of the above symptoms consult a competent doctor. Echocardiography would give the appropriate diagnosis and line of management in most cases. A pediatrician is your best guide who would direct you to a paediatric cardiologist for the same. Once you know that your baby has heart disease don't feel despondent. Most heart diseases can be treated.

Blue Babies

Blueness is an important indicator of heart disease. The blueness due to heart disease is present on fingers, toes, lips even when they are warm. However in normal children exposure to cold results in blueish discoloration of fingers and toes. This blueness disappears on warming the finger and toes. Blue babies always have a severe form of heart disease. Generally, earlier the blueness appears more serious is heart disease.

What To Do If The Baby Is Blue?

During the new born period, the most common cause is transposition of great arteries, i.e., the main arteries of the heart are coming from wrong ventricles. These babies also breathe fast and have feeding difficulty. Presently, this condition is completely curable. After confirming the diagnosis on Echocardiography, the babies are given a special intravenous infusion(PROSTAGLANDIN) to keep the arterial duct open which supplies the body with oxygenated blood in these cases.

Subsequently "ballooning" is done to increase the communication between the two sides of the atrium(SEPTOSTOMY). After this, the baby is stabilised and they undergo corrective surgery by 14-21 days of life. During surgery, the great vessels are disconnected from the ventricles and switched over so that they are connected to appropriate ventricles and the normal pathway of circulation is restored.

The other common condition which results in blueness within the first year of life is "Tetralogy of Fallot" physiology. Severe form may manifest at birth and need prostaglandin medicine followed by stenting of the artery to save the life. As these children grow, they are prone to get episodes of "Cyanotic spells" characterised by increase in the rate and depth of breathing with increased blueness. If prolonged, the child may become limp, convulse or become unconscious. These episodes need emergency treatment. Some children have episodes of breath-holding attacks following temper tantrums, and may become blue. These babies stop breathing transiently. These episodes do not indicate heart disease.

In Tetralogy of fallot the basic defect is a large hole in the ventricular septum and obstruction to the pulmonary blood flow. If the baby is stable the elective corrective surgery is done around 8-9 months of age with an ideal weight of 7-8 kgs. If the baby is symptomatic before that, palliative surgical shunt or percutaneous balloon dilation of the pulmonary outflow is done. This procedure increases the pulmonary blood flow and stabilises the patient. The corrective surgery is subsequently done after one year. These babies need iron supplements.

Blueness is an important sign of heart disease. You should not get intimidated or fear it. Timely treatment makes most heart diseases curable. It is better to consult your paediatrician who might ask you to get an opinion from a paediatric cardiologist in such cases.

(By Dr Neeraj Awasthy, Director of Paediatric Cardiology at Fortis Escorts, Okhla, Delhi)

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